Feature 10 Suture Lines of the Skull

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Acu-reflex points are formed along the suture lines of the skull. The acu-reflex points can be palpated along the coronal suture, sagittal suture, lambdoidal suture, and other sutures. Such acu-reflex points appear at the nasion, fontanelle, bregma, and pterion. When chronic headache is not adequately treated, sensitive points eventually appear at these locations.

Suprascapular nerve

Inferior transverse scapular ligament

Superior transverse scapular ligament

Suprascapular artery

Acromial anastomosis

Circumflex scapular artery

Suprascapular nerve

Inferior transverse scapular ligament

Circumflex scapular artery

Acromial anastomosis

Profunda brachii artery

Radial collateral artery, posterior branch

Inferior ulnar collateral artery -Ulnar nerve -Ulnar recurrent artery ' Cubital anastomosis i

Figure 7-6 The suprascapular nerve innervates both the infraspinatus and supraspinatus. An acu-reflex point is formed at the site of neuromuscular attachment.

Profunda brachii artery

Radial collateral artery, posterior branch

Inferior ulnar collateral artery -Ulnar nerve -Ulnar recurrent artery ' Cubital anastomosis i

Figure 7-6 The suprascapular nerve innervates both the infraspinatus and supraspinatus. An acu-reflex point is formed at the site of neuromuscular attachment.

Axillary nerve

Posterior circumflex humeral artery

Posterior cutaneous nerve of arm (radial nerve)

Inferior lateral cutaneous nerve of arm (radial nerve)

Radial collateral artery, anterior branch

Posterior cutaneous nerve of forearm (radial nerve)

Lateral cutaneous nerve of forearm (musculocutaneous nerve)

Summary of the Anatomic Features of Acu-Reflex Points

The 10 basic neuroanatomic features of acu-reflex points provide a solid foundation for understanding the nature of their structural configuration, pathophysiologic dynamics, and clinical importance for evaluating and selecting points during treatment, through the use of the INMARPS.

Other structures could also contribute to the formation of acu-reflex points. Japanese researchers, for example, have suggested a close association between some acu-reflex points and lymphatic channels.10

Each acu-reflex point can have one or more of the 10 basic anatomic features. As discussed previously, the neural configurations of the points were numbered according to their relative propensity to become sensitive. Acu-reflex points with lower numbers (e.g., site of the nerve trunk, numbered 1) usually become sensitive earlier and faster than acu-reflex points with higher numbers (e.g., suture lines of the skull, numbered 10).

Thus the deep radial nerve acu-reflex point on the forearm (H1, deep radial, with feature 1) always becomes sensitive before the superficial radial nerve point on the hand (H12, superficial radial, with feature 8). The former should be selected for needling first because it sends more therapeutic signals.

All sensitive acu-reflex points, no matter where they appear, are invariably formed in association with sensory nerves. Sensory nerves are extensively distributed in the structures of the soft tissue such as skin, muscles, ligaments, joint capsules, fascias, blood vessels, and bones.

Extensor digitorum longus Extensor hallucis longus Perforating branch (fibular artery) Anterior tibial artery ■ Anterior lateral malleolar artery Lateral malleolar network

Extensor digitorum and hallucis brevis muscles

Lateral tarsal artery

Dorsal metatarsal arteries

Dorsal digital arteries

Dorsal metatarsal arteries

Dorsal digital arteries

Dorsalis pedis artery

Deep plantar artery

Tibialis anterior, tendon Tibia

Anterior medial malleolar artery

Medial malleolar network

Anterior medial malleolar artery

Deep fibular nerve

Muscular branches (deep fibular nerve)

Medial tarsal arteries

Dorsalis pedis artery

Deep plantar artery

Extensor hallucis brevis, tendon

Extensor hallucis longus, tendon

Dorsal digital nerves of foot

FIGURE 7-7 Bifurcation of the deep fibular nerve on the dorsal surface of the foot, where an acu-reflex point (H5) is formed.

The sensitiveness of acu-reflex points arises from pathologic conditions affecting either peripheral nerve fibers or central neurons. Peripheral nerve fibers could be sensitized to form sensitive points by the chemicals leaking from damaged tissues. The neurons in the spinal cord could become sensitized by sustained stimulation of nerve impulses from peripheral receptors, as would occur in cases of chronic pain or cumulative trauma.12

Chronic pain is not like prolonged acute pain because the pain mechanisms involved are different. Acute pain is the warning signal of tissue injury that is locally restricted, whereas chronic pain is a disease that involves both peripheral and central sensitization.

Some sensitive points may indicate local damage in the affected area, but the local damage could at the same time produce distant pain by the mechanism of referred pain. An example of referred pain is angina pectoris, in which acu-reflex points palpated on the medial side of the left arm, the upper back, and the lower jaw are found to be sensitive.

Sensitive points may represent any type of damage of the tissue innervated by sensory nerves. For example, five acu-reflex points in the lumbar area and lower limbs are usually sensitive in the case of lower back pain, but the cause of the sensitivity could be any of several factors: nerve damage; infection or inflammation of the dura of the nerve roots; muscle contraction (mostly big muscles such as the erector spinae, although sometimes small muscles may be involved); pathologic problems with fascias, joint capsules, or ligaments; herniated discs; bone fracture; arthritis; infections; tumors; emotional disorders; and mechanical abnormalities between vertebrae.

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